Birthing positions in the real world
If I had a dime for every time somebody told me they didn't want to have their baby in a hospital (or work as a labor nurse instead of say, a homebirth assistant) because they didn't want to do the whole "strapped on her back on a cold table thing," I'd be a very rich woman. Who does that? Nobody. I've never—not once in 18 years—ever seen anybody strapped on her back on a cold table for a vaginal birth. Gawd, that's like something out of a Texas Chainsaw, Friday the 13th delivery room where all the nurses are axe-wielding monsters. I had coffee with a very young woman last week who was interested in entering the birth industry but wasn't sure which avenue to take. When I suggested getting a nursing license and becoming either as a nurse-midwife or labor nurse she said it: "I'm just not into that whole strapped on her back..." Aargh! Geez. What 70's book did this come from anyway? And why is this urban myth so pervasive?
Here's how it really goes: We use rocking chairs, birthing balls, Jacuzzis, showers and delivery beds—not cold tables. There are lots of bells and whistles on these beds, but no straps. We can raise the head, lower the feet, elevate the bed, pull up foot plates, attach squatting bars, drop the bottom away to make a nice delivery area but sorry, ladies, no straps. Stirrups—yes. When your legs are numb from an epidural or exhausted from pushing, it's nice to have somewhere to put them. Stirrups can be adjusted to any comfortable position our patient wants. Do we always use them? Heck no. But if we need them—they're convenient. Most of the time, it's Mom who asks for them or her family when their backs are sore from holding heavy legs.
We go to major trouble to make sure laboring women aren't flat on their backs. It's uncomfortable for mom and baby; lends to fetal heart rate problems (it compresses Mom's blood vessels and reeks havoc on their circulation) and is a lousy delivery position. We prefer side lying, squatting, semi-reclining or hands-and-knees. Anything's better than flat. We're strong supporters of staying out of bed and mobile during early labor. When it's time to lie down, it's frequently because Mom's tired and Mother Nature is telling her to conserve energy. No, this isn't when we pull our secret ropes out of the torture closet and tie her to her bed. This when we prop her up with as many pillows as we can find so she's comfortably supported.
Some babies start labor facing sunny-side up. This is called an occiput posterior position—when his face is looking up at Mom's bladder instead of down at her butt like he's supposed to. The back of baby's head presses on Mom's spine and it hurts. It makes for a tough fit through the pelvic bones and a lot of back labor. During labor, baby needs to rotate so the back of the head is up near Mom's bladder—occiput anterior.
Hands-and- knees and extreme side lying are two good positions for getting baby to turn around. Hands-and-knees you can probably picture. Extreme side-lying means Mom lies on her right or left side as far as she can go without actually turning onto her stomach. Then she places her top leg on the bed in front of her bottom leg. This gives baby space and the power of gravity to rotate in the pelvis. Both of these positions also relieve pain and pressure on Mom's back.
Most Moms find maintaining hands-and-knees on the floor uncomfortable. Luckily, modern-day delivery beds have lots of adaptations to help mom get into whatever position she wants, comfortably. I like putting the head of the bed way up and the foot down. Then mom positions herself on her knees, facing the back of the bed with her head cradled in her arms. If she ends up delivering in that position—the bed is designed so the bottom breaks away for easy access for the doc/midwife.
If mom wants to squat for delivery—no problem. We grab a squat-bar, attach it to the bed and mom either hangs onto it while she squats or we loop a sheet around it. Mom puts her feet on the bar and pulls on the sheet for all the leverage she can get.
I like the corkscrew method of pushing. I don't actually know if anyone else calls it that—but I do. We push with mom lying on her left side and stay there for 20 minutes. Then we move to hands and knees and push for 20 minutes. Then right-sided pushing then semi-reclining. We keep this up until baby works her way under the pelvic bone and finds her way home. Of course, elaborate pushing techniques are usually for first timers because, as I mentioned last week, second babies tend to come out lickety-split.
There are endless variations of delivery positions. Fitting baby's head through Mom's bones and vagina is like fitting a puzzle piece. Sometimes you have to wiggle it around until it all works. The most commonly used is probably a semi-reclining position. It's effective, fairly comfortable and easy on whoever's catching the baby. If Mom wants some other position or that one's not working, we change it up. If Mom has an epidural and isn't terribly mobile; we'll help her turn, change positions and push. Certain positions (like hands-and-knees) aren't feasible or even safe when your legs are numb but that's OK. There's still plenty of room for maneuvering.
The only time that whole "strapped flat on her back on a cold table thing" happens is in the operating room for cesarean sections. Even then, we put a wedge or towel roll under mom's hip so she's not flat (again, flat's no good for babies). We use an operating table because a bed's too wide. Surgeons have to work right over Mom's tummy without reaching. We do put a safety strap across mom's legs—not so we can torture her—so she won't fall off. Then we put a nice heated blanket on Mom and make sure she's comfy.
So, once and for all—can we put this whole scary-hospital delivery-torture thing to rest? I'm a labor nurse, not Freddie Kruger, not Chuckie, not even Nurse Ratched.
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